title: Importance of methicillin-resistant Staphylococcus aureus eradication in carriers to prevent postoperative methicillin-resistant Staphylococcus aureus surgical site infection.
abstract: Although infrequent, postoperative methicillin-resistant Staphylococcus aureus (MRSA) surgical site infection (SSI) is associated with significant morbidity and cost. Previous studies have identified the importance of MRSA screening to diminish the risk of postoperative MRSA SSI. The current study quantifies the importance of eradication of the MRSA carrier state to prevent MRSA SSI. Beginning February 2007, all admissions to an 800-bed tertiary care hospital were screened for MRSA by nasal swab using rapid polymerase chain reaction-based testing. Patients found to be nasal carriers of MRSA were treated with 2 per cent mupirocin nasal ointment and 4 per cent chlorhexidine soap before surgery. The subset of patients undergoing procedures that are part of the Surgical Care Improvement Project (SCIP) were followed for MRSA SSI (n = 8980). The results of preoperative MRSA screening and eradication of the carrier state were analyzed. Since the initiation of universal MRSA screening, 11 patients undergoing SCIP procedures have developed MRSA SSI (0.12%). Of these, six patients (55%) had negative preoperative screens. Of the five patients with positive preoperative screens, only one received treatment to eradicate the carrier state. In patients who develop MRSA SSI, failure to treat the carrier state before surgery results in MRSA SSI.
authors.affiliation: Division of Clinical Effectiveness, Department of Surgery,The Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA. pofahlw@ecu.edu
authors.forename: Walter E
authors.initials: WE
authors.lastname: Pofahl
authors.forename: Keith M
authors.initials: KM
authors.lastname: Ramsey
authors.forename: Delores L
authors.initials: DL
authors.lastname: Nobles
authors.forename: M Kathy
authors.initials: MK
authors.lastname: Cochran
authors.forename: Claudia
authors.initials: C
authors.lastname: Goettler
mesh_terms: D000281:Administration, Intranasal; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002353:Carrier State / Q000382:microbiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification*; D008875:Middle Aged; D016712:Mupirocin / Q000008:administration & dosage; D009296:Nasal Cavity / Q000187:drug effects / Q000382:microbiology; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D012189:Retrospective Studies; D020133:Reverse Transcriptase Polymerase Chain Reaction / Q000379:methods; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000517:prevention & control*; D013530:Surgical Wound Infection / Q000382:microbiology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D016712:Mupirocin